Zoe Robinow1, Kathleen Barnett1, John Geraghty1,2. 1. California Northstate University College of Medicine, Elk Grove, CA. 2. Kaiser Permanente Medical Center, Roseville, CA.
Abstract
BACKGROUND: Spontaneous spinal cord infarctions are rare, especially in the conus medullaris (CM). They are a particularly uncommon presentation in patients with familial Mediterranean fever (FMF). CASE DESCRIPTION: Our patient is a 50-year-old man with FMF, controlled with colchicine for 20 years, who presented to the emergency department when he developed the inability to ambulate without assistance. He also had bowel and bladder incontinence after experiencing burning in his thighs, scrotum, and penis that radiated down his legs. A magnetic resonance imaging scan with and without gadolinium showed T2 hyperintensity changes in the CM and L2 vertebral body, with enhancement of the CM and cauda equina. The patient received high-dose steroids while hospitalized without clinical benefit. He noted improved strength over the past several months, particularly in his left leg, but has persistent sensory disturbances in his buttocks, scrotum, and plantar surfaces. He continues to experience bowel and bladder incontinence. CONCLUSION: Although CM infarction is rare in patients with FMF, it should be considered in the differential diagnosis when there is a high index of suspicion. The presence of vertebral body infarction with T2 changes on magnetic resonance imaging will indicate similar pathology in the CM.
BACKGROUND: Spontaneous spinal cord infarctions are rare, especially in the conus medullaris (CM). They are a particularly uncommon presentation in patients with familial Mediterranean fever (FMF). CASE DESCRIPTION: Our patient is a 50-year-old man with FMF, controlled with colchicine for 20 years, who presented to the emergency department when he developed the inability to ambulate without assistance. He also had bowel and bladder incontinence after experiencing burning in his thighs, scrotum, and penis that radiated down his legs. A magnetic resonance imaging scan with and without gadolinium showed T2 hyperintensity changes in the CM and L2 vertebral body, with enhancement of the CM and cauda equina. The patient received high-dose steroids while hospitalized without clinical benefit. He noted improved strength over the past several months, particularly in his left leg, but has persistent sensory disturbances in his buttocks, scrotum, and plantar surfaces. He continues to experience bowel and bladder incontinence. CONCLUSION: Although CM infarction is rare in patients with FMF, it should be considered in the differential diagnosis when there is a high index of suspicion. The presence of vertebral body infarction with T2 changes on magnetic resonance imaging will indicate similar pathology in the CM.
Authors: Sebastian Luger; Patrick N Harter; Michel Mittelbronn; Marlies Wagner; Christian Foerch Journal: Clin Exp Rheumatol Date: 2013-05-27 Impact factor: 4.473